Taking low-dose aspirin is associated with 20% reduction in cancer deaths | Hacker News Reader

Taking low-dose aspirin is associated with 20% reduction in cancer deaths

cardiff.ac.uk

142 pointsgeox79 comments

This has to be balanced against this news: "Daily low dose aspirin increases brain bleeding risk by 38% in older adults." See: https://www.medicalnewstoday.com/articles/low-dose-aspirin-r...

It should be noted that you can get a lot of aspirin from vegetables, which also contain aspirin.

This video talks about a similar study and the plant foods that have highest doses of aspirin, all without stomach bleeding.

https://www.youtube.com/watch?v=BcmoILbgmwc

Which is worse?

I know which one I would rather die from. It isn’t cancer.

Well the worseness has to be counteracted by how likely it is. A 38% increase in something quite rare (brain bleeds) is nowhere near as impactful as a 20% reduction in cancer, which is much more common.

From 0.8% of people averaging 70 years of age to 1.1%. I’ll take those odds, cancer is hell.

Note that the patients in the meta-analysis already had cancer.

Yes, we need to see a long-term study of all cause mortality before recommending this intervention for primary prevention.

There are probably many as per article.. here is one: https://aspree.org/aus/for-clinicians/

Focused on elderly, i think mostly started with subjects at 70? So depends on how 'long term' you mean. :)

100% reduction in cancer deaths in those with self inflicted gunshot wounds to the head

Brain bleeding is very rare. That 38% number is a *relative risk ratio*. I'm always wary of studies that use such ratios to make an effect seem large. The following excerpts from the article you cited state:

For the study, the researchers analyzed data from 19,114 adults with an average age of 74 years old.

Altogether, 1.1% of those taking aspirin (108 individuals) experienced intracranial bleeding, while the same was true for 0.8% of those taking a placebo (79 individuals).

It always amazes me how you can take numbers and twist them they way they fit you and be technically correct. I bet many (if not most) people will only remember the headline.

Check out the famous book "How to Lie with Statistics"

This is the book that was next to Bill Gates during his television interviews a few years back when we considered him a health professional.

It says in older adults.

This is a meta-study, touching on that "contrast" already: there is a subsection in the paper dedicated to this, where they claim that

"The major factor in cerebral bleeding however is hypertension, and in an RCT of aspirin based on more than 18,000 hypertensive patients—all of whom were receiving ‘optimal’ antihypertensive treatment—there were no additional cerebral bleeds in patients randomised to aspirin" (Refs 46 and 47).

which seems to be in contradiction with the article corresponding to the news you linked to: https://jamanetwork.com/journals/jamanetworkopen/fullarticle... and strangely doesn't cite or comment on Refs 46 and 47 from the paper of the main thread, possibly because they don't seem to be focusing on older adults.

There is also a subsection on gastrointestinal bleeding.

Intracranial bleeding isn't necessary something that cause permanent damage, or lethal by the way.

Aspirin is also associated with gout. I'm not sure if the dosage required to worsen gout is lower than the dose discussed in the paper. I merely caution that anyone thinking about increasing their aspirin usage to prevent cancer should consult a GP first, since it's complicated, and anyone who has had gout probably doesn't want to increase their rate of flare ups.

I was curious about possible mechanisms, so I followed the link to the paper and was pleased to find they're discussed.

https://www.nature.com/articles/s41416-023-02506-5

This is a meta analysis of observational studies. There's random controlled trial which showed all cause mortality was 14% higher for "healthy older adults who received daily aspirin than among those who received placebo"

https://www.nejm.org/doi/full/10.1056/nejmoa1803955

The meta analysis is studying asprin as a cancer treatment, so the subjects were patients who already had cancer, not healthy adults taking it as a preventative. Daily asprin could both be bad for healthy adults and good for cancer patients.

Probably more like lower inflammation reduces all cause mortality.

I wonder if this is a reduction in mortality that was caused by an increase in chronic inflammation from modern life, stress and obesity.

In a healthy fit human, inflammation is a good thing, it is the body's construction and maintenance crew. Chronic inflammation is not good, but that is a side effect of an underlying issue (in my understanding so far)

if you're periodically under construction that's a good thing.

if you're always under construction it means shit is falling apart

There’s detailed but clear explanation in the paper that it’s doing anticancer things not related to reducing inflammation.

People who are diligent to keep taking an aspirin pill day in and day out even though they are not sick are likely sufficiently worried about their health to also subject themselves to timely cancer screening.

This is a study of cancer patients, not the general population.

Reminds me of Ray Peat: https://raypeat.com/articles/aging/aspirin-brain-cancer.shtm...

Disclaimer: A lot of his stuff is pretty out there, and some of it may be outright wrong. I don’t recommend following his advice, but a lot of his writing is at least interesting.

https://www.youtube.com/watch?v=gcR2k4Olhms Aspirin Alert: The Hidden Risks Revealed Dr Brad Stanfield

Low-dose aspirin shouldn't be taken blindly. There was also hope triflusal was going to be safer than aspirin, but it's didn't do much better either.

https://www.stroke.org/en/life-after-stroke/preventing-anoth...

https://n.neurology.org/content/62/7/1073

https://pubmed.ncbi.nlm.nih.gov/29866011/

although indiscriminate long term aspiring can cause GI side effects

I've heard it's good to take with milk.

Common misconception, it's actually best to take with alcoholic beverages containing dairy. So like a white Russian.

(I'm obviously joking, this is your friendly reminder not to take medical advice from randos on the internet, especially when their source is "I've heard").

I did hear something from a stranger about hearing somethings on internet from strangers so this tracks, it would seem. I will comply fully henceforth!

but now you have trained bing, so millions will die

GP is a bad user. Bing is a good Bing.

But they told me to aim high!

Only for some people, I've taken low dose aspirin (family history of heart attack) for 20 years now without any side effects (except perhaps not dying from heart attacks)

Also addressed in TFA, it turns out. GI symptoms are pretty mild in the universe of cancer drug side effects, and the aspirin slows metastatic cancer spread considerably, so seems like a no brainer.

It isn't a cancer drug, so that isn't a fair comparison. GI symptoms from eating more broccoli and not ever drinking are also pretty mild compared to cancer drugs. Aspirin appears to be a preventative according to some initial research. National cancer institute says even the most at-risk age group (age 60+) is still only has cancer rates of around 1 in 100. How long are you going to take low dose aspirin?

Are GI symptoms mild if you take low dose aspirin on a daily basis for 30 years? 40? Longer even? All to reduce your odds of getting cancer from 1 in 100 to 1 in 120 at the latest stage of your life. The gains are marginal in younger stages of your life where cancer rates are much lower.

Don't get me wrong, if this is validated it's a very interesting result. A mechanism of action could be potentially groundbreaking. It doesn't mean start taking aspirin every day for the rest of your life at age 38 just to be on the safe side, however.

It is also worth considering that this is purely an association at this point. It is possible that some of this effect is because cardiovascular disease, the primary reason for taking low dose aspirin, tends to kill people before the odds of getting cancer have time to really flex their muscles. We might assume that ethical researchers without perverse incentives working within a system primarily concerned with scientific truth would have ruled out that possibility... but then we would be idealists who are ignorant of how the world works. Or any other number of reasons why this might turn out to be a big old pot of nothing to get excited about.

Long term low-dose aspirin regimes are well studied and common (for cardiovascular protection). This isn't some oddball thing the study is suggesting people do; the reason they were able to survey over 1MM pts is that so many people are already doing this.

Meanwhile --- and I say this as a stalwart enjoyer and advocate of crucifers of all kinds --- broccoli is simply not associated with dramatic suppression of cancer metastases.

The study population was cancer patients, so low dose aspirin was studied as a cancer drug. It doesn't say what the effect would be in the general population. Don't take aspirin just because it might help cancer patients, but if you've had cancer, consult with your oncologist.

> It doesn't mean start taking aspirin every day for the rest of your life at age 38 just to be on the safe side, however.

Younger people than that do get cancer and die from it. If it arrests tumour growth and even sometimes causes reduction and one is at risk, resisting aspirin treatment out of cargo cult common sense is a bad idea.

1 in 100 cancer odds is off by at least an order of magnitude. From the studies I've read, lifetime risk of cancer is about 1 in 3.

This should be used as an icebreaker in college. "Look to your left, then look to your right. One of you will die of cancer."

Increases risk for hemorrhagic strokes as well. AFAIUI, your clotting ability is impaired, so if you get a minor bleed, it's not minor for long.

IIRC, the recommendations to folks taking aspirin for heart attack prevention is "don't, unless you've already had an ischemic event" because the risk outweighs the benefits for everyone else. That could change if we find new and/or unexpected benefits from low-dose aspirin.

I am very skeptical about these side effect claims. Do you have hard data supporting this or doctor hearsay. Years ago I remember watching Charlie Rose Brain series where one of the professors said something like “ we know of two drugs that we are certain are very safe for human beings: alcohol and aspirin.”

> “ we know of two drugs that we are certain are very safe for human beings: alcohol and aspirin.”

I am not sure I understand. We know alcohol isn’t safe, let alone very safe, in any quantity. So immediately this seems contradictory?

That appears to have been the point.

Aspirin's bleeding risk is very well studied. You can find many papers showing between around 30% increase in the brain, and around 60% for the gut.

Anecdata: even a few days of low-dose aspirin causes me terrible GI pain and exacerbates an otherwise 30-year dormant ulcer. I would love to be able to take it, but I can't tolerate it at all.

What was your dosage? Tried dissolving in water?

Have you tried the "enteric coated" aspirin? The coating is supposed to resist dissolving until the pill is well past your stomach.

Those are both drugs with very significant risks

Alcohol has a bunch of recent studies showing that no amount is good, and as little as two drinks per week yield measurable negative impacts.

what if I do all the other things that go along with drinking for health, like speak Italian or French while I drink?

First search hit:

  They report preventable deaths caused by alcohol is higher in France than anywhere else in Europe.

Speaking French doesn't appear to help you. Maybe Italian is better.

meh, I just care about all-cause mortality. I'll accept some preventable death risk if it's outweighed by non-preventable death risk improvement.

I think the French hit a good sweet spot between high alcohol consumption and high life expectancy. Quite a male-female disparity though. Maybe Irish do better at 0.2years reduction for an extra 0.4l of alcohol per year

https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...

https://en.wikipedia.org/wiki/List_of_countries_by_alcohol_c...

Sounds like bs if you look at Russian numbers.

Almost all strokes are ischemic strokes.

but heart attacks are not strokes

Thank God we cleared that up.

You are welcome, it’s easy to get confused when trying to comprehend passages on the internet.

yes, hemorrhagic strokes are less frequent, but much worse. I don't think it's quite a wash in the end, but closer to one if all we care about is outcomes (and that's all I do!)

I'm annoyed that the FDA has kept cox-2 selective inhibitors restricted when the data I've seen shows they have lower GI risks and similar cardiovascular risks as other NSAIDs.

because the FDA are sticks-in-the-mud who get blowback when they approve something bad and but barely hear anything if they delay or restrict something good. there was also a to-do about celecoxib potentially increasing risk of heart attacks, plus the off-label marketing thing that led to the largest (at the time) settlement of that sort in history.

the process was also crazy complicated until some new 2020 legislation. the FDA published monographs saying things like "you can make a pain reliever with the following active ingredients and in the following forms." for example, no changes to the monographs on cough and cold medicines were made between 1987 and 2020. the new regime is of course a new mess to figure out, and consumers won't necessarily know the difference between a selective versus nonselective cox inhibitor. so you spend all this money and maybe inertia just keeps people buying ibuprofen and naproxen because it's what they know. and marketing something explicitly as "safer than ibuprofen" would be a massive hurdle to get cleared.

you can find all the FDA's monographs here, where it lists specific ingredients, concentrations, labeling, and testing procedures. https://dps.fda.gov/omuf/monographsearch

Oh i remember reading all of these studies 10 years ago and thinking they had so much potential relative to the small but significant risk in MI. I hope they are reevaluated at some point.

Silver lining to taking it after my heart attack.

> The Welsh Aspirin Group in Cardiff University has published a systematic review…

Does this Aspirin group have any connections to producers? Is this an ad?

Im currently in Cardiff University. I wonder if I can just go and ask them about it

Are we microdosing aspirin now?

/e: on a more serious note, what @codevark was downvoted to oblivion for: I'd be interested in a comparison of the anti-inflammatory aspect of aspirin vs food/diet. Anyone got an idea?

Can I still drink alcohol and smoke weed everyday, and then take some baby aspirin to offset the increased probability of an early death?

Doubt it ;)

Cheers old buddies.

Now combine that with extra fiber and you'll practically live forever: https://news.ycombinator.com/item?id=38523805

If you climb 50 steps a day as well, you may become unstoppable: https://news.ycombinator.com/item?id=38425724

And fewer calories…

And time restricted feeding (ie 8/16 intermittent fasting)

https://www.nature.com/articles/s41392-022-01163-z

thanks, that's funny!

Tomorrow's news will say it will be a 20% increase in some other desease...

Depends on the disease, I might make the trade. Cancer is awful.

Found it already! In today's news:

> Currently, a number of randomised trials which test aspirin and mortality are in progress. These focus upon the common cancers: colon, breast, prostate and one in lung cancer. One of these trials, based upon 3021 selected patients in remission from a HER2-negative breast cancer, has already reported [31]. This trial was ended prematurely because aspirin was associated with a possible increase of about 25% in deaths.

Classic baby/bathwater disposal problem. There are plenty of medicines that are beneficial for some applications but harmful for others. Maybe all of them, to some extent? That's why the authors wrote dozens of other sentences in that article.

Aspirin is anti-inflammatory. A huge number of illnesses are caused or worsened by inflammation. Aspirin is likely to show benefit for a huge variety of conditions.

this is my napkin math read as well, but aspirin is an inhibitor of both COX-1 and 2 with somewhat higher affinity for the former. this leaves you messing with something else that's important for regulating platelets, your gut, etc. even selective inhibitors of the latter aren't out of the woods yet. there's some literature that's starting to suggest COX-2 may be at least somewhat constitutive in some tissues (endothelium, hence coronary vasospasm) even if it's also mostly inducible.

not sure why no one has tried developing a prostaglandin e2 inhibitor instead. going further downstream might be safer.

This was my first thought.

It's a complicated topic, biochemically / physiologically, however. Guidelines and recommendations have changed many times in the past couple of decades. With the scale of epidemiological data collection and specific studies carried out in recent years, conclusions are still rather "mixed".

There are many reasons to think, mechanistically, that aspirin (acetylsalicylic acid) should come out "net positive" in its effects on human health. But, even some of the "prostaglandins", for example, can be important in endothelial function and health (in a positive way).

I will note that I haven't kept up with this topic much in at least 5 or so years, but, I can point to a couple of sources with some analysis / discussion that should be of use to most, I think:

https://www.cuimc.columbia.edu/news/aspirin-making-sense-cha...

https://www.uspreventiveservicestaskforce.org/uspstf/recomme...

https://jamanetwork.com/journals/jama/fullarticle/2791399

https://www.annualreviews.org/doi/10.1146/annurev-pharmtox-0...

I specifically remember concerns roughly 10+ years ago that some of the expected net benefits might, in fact, actually be net harms in the broader population - particularly for other NSAIDs (non-steroidal anti-inflammatory drugs), but, even, at some point not long thereafter, for "aspirin" as well. I may dig out that info if I get a chance to try to refresh, myself, and will comment again if / when I do.

I always think of Lewis Black's bit on this, though (while pointing out that this is the nature of science and its best to go with the best info available at any time, generally, IMO):

https://youtu.be/iRsTtzYhTxk?t=5m27s

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